What is health psychology?

Introduction

Health psychology is concerned with the psychdiaological components of
promoting and maintaining health, treating and preventing illnesses, improving
health care services, and developing health care policy. Health psychology seeks
to generate new knowledge about people’s health beliefs and practices and to apply
existing knowledge to improve health and well-being. Psychologists interested in
health psychology generally adhere to the belief that health cannot be understood
exclusively by focusing on the physical condition of the body. The psychological
side—the state of the mind—must be considered as well.

The Biopsychosocial Model

The relationship between mind and body and its impact on health are best
understood by using what has been labeled the biopsychosocial
model. This model assumes that one’s health state is based on
the often-complicated interactions of three sets of factors: biological factors,
psychological factors, and social factors. Biological factors include genetic or
inherited influences that may predispose some individuals to be more susceptible
than average to certain maladies such as heart disease. Examples of psychological
factors could include the amount of stress an individual experiences, a
personality trait such as optimism, or the degree of belief in control over one’s
own health. Support and empathy one receives from family, friends, or colleagues
constitute social factors. Such social support can come in the form of
emotional, informational, or even tangible resources such as financial assistance.
Other social factors that play roles in health and illness are cultural, ethnic,
and gender differences.

Thus, the biopsychosocial model assumes that health is based on more than the
absence of illness; it is also based on attaining physical, social, and mental
well-being. Indeed, this model highlights the role of psychosocial variables.
Psychosocial variables can be internal mental states, such as depression,
or external situational factors, such as the quality of social support one
receives. The important point is that psychosocial factors should be examined in
combination with, not independent of, biological influences.

Although this model’s biological aspects are readily accepted as important to understanding health, the psychosocial components are controversial in some areas in which the biomedical model is heavily relied on. This more traditional model assumes that disease or illness is exclusively biological in nature, so that diagnosis and subsequent treatment are focused on the state of the body as distinct from the mind. The controversy concerning the biopsychosocial model is relatively minor, however, because there is a recognition among many researchers and health professionals that psychosocial variables often add more to knowledge concerning health, illness, and disease than do biological factors alone.

The Rise of Lifestyle Diseases

The rise in interest concerning psychosocial variables specifically, and health
psychology generally, can be attributed in part to the changing conditions of
health problems. Because of advances in disease prevention, vaccination, and other
biomedical treatments, many of the primary health problems are no longer major
infectious diseases, such as polio, smallpox, or
rubella. (Acquired immunodeficiency syndrome,
AIDS, is one important exception.) The threat of these acute diseases has been
successfully eliminated through vaccination programs, which resulted in a doubled
life expectancy within the twentieth century. This increased life span, however,
has a price. A collection of more chronic and age-related diseases, including
cancer, heart disease, and stroke, are
increasingly prevalent health problems worldwide. Unlike infectious diseases,
these threats cannot be treated through vaccination because they are largely
caused by people’s lifestyles or aging.

The intriguing aspect of these modern lifestyle diseases is that they have a significant behavioral component and may be
preventable. Ironically, most people are probably aware of ways they could reduce
their susceptibility to these diseases, yet they choose not to change their
lifestyles. To decrease the risk of lung cancer, for example, people who smoke
should pursue smoking cessation treatments. Heart disease can be
controlled through improved diet and a moderate amount of exercise. Alcohol
consumption should be moderate, and recreational drugs should be avoided
altogether. Making people aware of the origins of these lifestyle diseases is no
longer the key problem. It has been replaced by the problem of how to alter
negative behaviors affecting health. Many of these negative behaviors, such as
binge
drinking, have rewarding short-term consequences that
increase these negative behaviors more effectively than delayed punishment, such
as a hangover, can decrease them. Health psychologists are interested in
researching motivation, coping strategies, and other behavioral
modification techniques and therapies that promote health and well-being.

Some advances in dealing with the problems of lifestyle and behavior have been
made. There has been a downward trend in smoking; more people are aware that
exercise and eating healthier food improves the quality and quantity of life.
However, people in industrialized countries are showing alarming increases in
obesity and decreases in physical activity. Finding ways to
alter health behaviors is one of the major contributions health psychologists can
provide, one that relies on an understanding of biological as well as psychosocial
factors in health.

The changing nature of illness, related in complex ways to biology and
behavior, must be understood in relation to broader issues in health psychology,
such as the expansion and development of adequate health care services.
Preventable illness account for the bulk of health care costs in the United
States. In 2012, Forbes magazine reported that obesity accounted
for a staggering $190 billion in annual national health care costs, exceeding only
smoking in terms of health care costs. A 2012 study published in the
Journal of Health Economics estimated that obese men account
for an additional $1,152 annual in medical spending, predominantly due to
hospitalizations and prescription drugs, and obese women account for an additional
$3,613 per year. This money supports escalating health expenses such as health
care, health care workers’ jobs, and health-related research. Health psychology
seeks to address these issues as well as make recommendations concerning future
directions for health care.

Optimism and Heart Surgery

Because health psychology encompasses both theoretical and applied elements,
researchers work in both laboratory and field settings. Given the variety of
research efforts that potentially fall within the bounds of health psychology,
only a brief review of representative pieces of research is possible. This review
will be highly selective, focusing on two studies that explicitly link
psychosocial variables to health-related issues: recovery following coronary
artery bypass surgery and adjustment to a nursing care facility.

Heart disease is an important topic within health psychology because it
accounts for more deaths annually in the United States than all other diseases
combined. Each year, many persons require life-saving cardiac surgery to increase
blood flow to the heart, thereby decreasing the risk of subsequent heart attack.
The surgery itself, however, can be a stressful and physically and emotionally
draining experience. It is useful for medical professionals to be able to predict
which patients will cope better with the coronary artery bypass operation and show
more rapid rates of recovery.

Michael F. Scheier and Charles S. Carver have argued that a personality trait they call “dispositional optimism” can lead to more effective coping with a threatening event such as heart surgery. Dispositional optimism refers to a person’s general belief that positive outcomes will occur in the future. If individuals can envision good things happening in the future, then these expectations might allow them both to cope effectively with and to recover more quickly from the surgery. Pessimists, those who anticipate relatively negative outcomes, might show a slower rate of recovery and poorer adjustment to the surgery.

In an article published in the Journal of Personality and Social Psychology in 1989, Scheier, Carver, and their colleagues assessed the optimism of a group of middle-aged men one day before their coronary artery bypass surgeries. As expected, following surgery the optimists showed earlier signs of physical recovery, such as walking around their hospital rooms, than did the pessimists. They were also judged by the medical staff to have demonstrated faster recovery rates. After six months, optimists were more likely to have resumed their normal routines of work, exercise, and social activity and to have done so more quickly than the pessimists. Furthermore, there is accumulating evidence that even mild depression, which is related to pessimism, increases the chances of death from a future heart attack.

Clearly, a more optimistic orientation can lead some people to deal effectively
with adverse health problems. It may be that dispositional optimism promotes a
reliance on useful coping strategies, such as making future plans or setting
goals. In turn, these strategies affect one’s adjustment to the physical illness.
Further research has shown that optimism leads people to seek social support and
to focus on the positive aspects of stressful events. As a psychosocial variable,
then, dispositional optimism has important implications for adjusting to physical
problems related to disease. Health psychologists are interested in studying and
reinforcing positive coping strategies for individuals with chronic
illnesses or terminal diseases.

Control in the Nursing Home

Other psychosocial variables are relevant to adequate adjustment to health
problems posed by particular environments. Many older adults may need to live in
nursing care
facilities because of health or economic difficulties. Such
facilities provide adequate shelter and health care, but they frequently operate
under fixed financial resources which limit the individualized activities and
freedoms enjoyed by their residents.

Writing in the Journal of Personality and Social Psychology in
1976, Ellen J. Langer and Judith Rodin argued that such institutional environments unwittingly reduce morale and health by gradually taking
away the patients’ perceptions of control over daily events. As a psychosocial
variable, the perception of control is the belief that one can influence outcomes.
Nursing home residents may lack such perceptions of control in nursing homes where
almost no aspect of their environment is their responsibility. Practically all
decisions, from hygiene to entertainment, are made for them by staff members.

Langer and Rodin reasoned that by creating opportunities for patients living in
nursing homes to perceive even relatively small amounts of control and autonomy,
their health and well-being might improve. To test this idea, these researchers
gave one floor of patients in a nursing home plants to care for and then asked
them to make some decisions regarding participation in recreational activities in
the facility. Patients on a comparison floor also received plants but were told
that the nursing staff would be responsible for their care. This group also
participated in the same recreational activities but made no decisions about them.
Several weeks later, staff observations and comments made by the patients showed
that those individuals who perceived control were more physically active and had a
stronger sense of well-being. One year later, those patients who were made to feel
responsible for events in their environment were still physically and
psychologically healthier, even exhibiting a lower mortality rate than those who
did not perceive control.

Perceived control is only one psychosocial variable that can be linked to
environmental effects on health and well-being, just as nursing home residents
represent only one group who may benefit from interventions of this sort. Based on
these results, however, a few conclusions can be drawn. Perceived control can be
engendered in fairly simple ways with profound effects on people’s physical and
mental health. The adverse effects of some environments, such as institutions that
care for patients with chronic health problems, can also be reduced. Finally, some
health interventions can be implemented in a cost-effective manner. Many
applications of the biopsychosocial model are clearly possible.

Evolution of the Field

The belief that a sound mind leads to a sound body is by no means novel. The
medical and psychological communities have long operated under the assumption that
mental and physical states affect one another, though active cooperation between
professionals in these two fields was limited. Psychiatry, for example, served as
one of the bridges for communication between these groups. Within psychology
itself, there have always been scholars whose research focused on health and
medical issues, although they tended to identify themselves with areas such as
clinical, social, or physiological psychology.

In the late 1970s, there was growing recognition that a distinct subdiscipline
of psychology relating to health matters was coalescing. Various names for this
subdiscipline, such as behavioral medicine, medical psychology, and behavioral
health, became more common, as did specialized journals, texts, symposia, and
organizations. A division of health psychology became an official part of the
American Psychological Association in 1978. Health psychology has since become
more formalized, articulating its goals, defining its scientific and professional
orientations, and evaluating the training needs of students drawn to it. One
prominent health psychologist, Shelley E. Taylor, has described the field as a
“maturing discipline.”

Because philosophers have always speculated about the association between mind
and body, the philosophical roots of health psychology can be located in antiquity
and traced forward to modern times. Psychology’s interest and experimental
approaches are more recent developments. From the 1930s to the 1950s, researchers
such as Flanders Dunbar and Harold Wolff attempted to link personality variables
and psychosocial stressors to specific diseases. In the early 1960s, Stanley Schachter
and Jerome E. Singer examined the role of cognitive and physiological processes in
the perception of emotional states. In related work during the same period,
Richard S. Lazarus pioneered the study of stress and coping.

In the twenty-first century, diseases with strong behavioral components such as
type 2 diabetes, heart disease, and various types of cancer will
continue to be major concerns. The human genome will provide new insights into
interplay of genes and behavior in the development of health and illness. The
developing field of psychoneuroimmunology, which is the study of the complex interplay of behavior, the nervous system, the endocrine system, and the
immune system, will take on more significance. For example,
psychoneuroimmunological research is progressing rapidly on the effects of social
stress on upper respiratory infections and speed of wound healing. Finally, the
new discipline of positive psychology will become infused into health psychology.
Martin E. P. Seligman and Mihaly Csikszentmihalyi wrote in American
Psychologist in 2000 that scientific study of the development and
fostering of positive traits in humans and their institutions will eliminate many
of the mental and physical maladies that affect the human condition. Scientific
research in the twenty-first century will help to develop and foster traits such
as hope, wisdom, creativity, courage, and perseverance and will determine how
these traits can positively influence health and allow individuals and social
groups to thrive.

Because of this growing interest in health threats, health psychology may
increasingly adopt a salutogenic rather than a pathogenic focus. A salutogenic
focus seeks to understand the origins of health by attending to those factors that
promote people’s health and psychological well-being. Healthy people behave in
ways that keep them healthy, and researchers attempt to uncover the aspects of
healthy and happy lifestyles that may aid individuals suffering from illness or
disease. In contrast, a pathogenic focus highlights the causes of illness and
disease and is less prevention-oriented. This is not to say that the cause of
illness is a secondary concern. Rather, the onset of illness should be understood
in relation to behaviors and psychological factors that maintain good health.

Health psychology promises to continue as an important arena for interdisciplinary research on health. Basic and applied approaches to understanding health will develop by examining the interplay of biological, psychological, and social factors. As a growing subdiscipline of the field of psychology, health psychology will yield intriguing insights regarding the relationship between mind and body.

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